SUBCUTANEOUS (SC) delivery of immunotherapies for solid tumors has emerged as a potentially transformative approach to cancer treatment, promising comparable clinical efficacy to intravenous (IV) therapies while significantly reducing treatment time and burden on healthcare systems. With recent FDA approvals for SC atezolizumab and nivolumab, the oncology field is examining whether these innovations can deliver on their promise of enhanced access and efficiency.
Clinical trials underpinning these approvals demonstrated noninferiority in pharmacokinetics, objective response rates, and progression-free survival between SC and IV formulations. Importantly, SC delivery also showed lower rates of infusion-related reactions and reduced administration times, dropping from hours to minutes. For example, SC atezolizumab takes under 10 minutes to administer, compared to more than 30 minutes for its IV counterpart. Such time savings not only benefit patients but also allow clinics to treat more individuals within the same timeframe, improving overall capacity.
Operational gains are clear: less chair time, reduced pharmacy preparation, and fewer nursing hours. These improvements could dramatically increase throughput in busy oncology centers. However, integrating SC options into regimens that still require IV chemotherapy complicates clinical workflows, limiting the full realization of these efficiencies.
Despite clear logistical advantages, the economics of SC immunotherapy present challenges. SC formulations often require higher doses to match IV bioavailability, potentially raising drug costs. Moreover, current reimbursement rates for SC injections are significantly lower than for IV infusions, posing a threat to the financial sustainability of infusion centers, particularly those already facing staffing constraints.
Compounding the economic uncertainty is the growing presence of lower-cost IV biosimilars, which may undercut SC uptake. Additionally, the potential for increased out-of-pocket costs for patients remains a concern if insurance coverage does not keep pace with delivery innovation.
In summary, SC immunotherapy represents a step forward in patient-centric oncology care, offering real-world advantages in efficiency and convenience. However, its success will depend on thoughtful integration, pricing strategies, and updated reimbursement models to support its use without undermining access or sustainability.
Reference:
Ibodeng G et al. Subcutaneous Immunotherapies in Solid Tumors: Are We Truly Expanding Access and Efficiency? JCO Oncol Pract. 2025. https://doi.org/10.1200/OP-25-00052.
